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Nursing Leadership and Management

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This discusses the basic theories and principles in nursing administration, leadership and management.

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Nursing Leadership and Management

  1. 1. NURSING LEADERSHIP AND MANAGEMENT RYAN MICHAEL FLORES ODUCADO PhD ©, MAN, MAEd, RN, USRN, RM, CRN
  2. 2. PRE TEST ACTIVITY 1. MONITORING 2. MISSION 3. STAFFING 4. POLICY MAKING 5. AUDIT 6. JOB DESCRIPTION 7. QUALITY ASSURANCE 8. SUPERVISION 9. DISCIPLINE 10.BUDGETING
  3. 3. MANAGEMENT LEADERSHIP PROCESS OF GETTING THINGS DONE THROUGH PEOPLE PROCESS OF INFLUENCING OTHERS
  4. 4. MANAGEMENT LEADERSHIP
  5. 5. MANAGER LEADER
  6. 6. PRACTICE TEST 1.Do things right 2.Emphasizes interpersonal relationship 3.Seeks change 4.Inspires and motivate others 5.Have an assigned position within the organization
  7. 7. TWO OR MORE PERSON engaged in a SYSTEMATIC and COORDINATED effort to PRODUCE GOODS AND SERVICE Form of every HUMAN ASSOCIATION for attainment of COMMON PURPOSE
  8. 8. ATTAINMENT OF OBJECTIVES POOLING OF RESOURCES LEARNING, COMPENSATION AND SERVICE
  9. 9. The Organization and Its Environment The Broad Environment Socio-cultural Forces Economic Forces Technological ForcesThe Task Environment The Organization Owners/ Board of Directors Managers Employees Government Agencies & Administrators Suppliers Competitors Unions Local Communities Activist Groups Customers Political & Legal Forces
  10. 10. SWOT ANALYSIS • a method of analyzing an ORGANIZATION’S COMPETITIVE SITUATION that involves assessing organization’s STRENGTHS WEAKNESSES OPPORTUNITIES THREATS
  11. 11. STRENGTHS • Expertise personnel • Qualifications personnel • Financial status • Quality of patient care WEAKNESSES • Understaffed • Poor capital • Scarcity of supplies and resources OPPORTUNITIES • Increase demands • Improve or new facilities • Recruitment personnel • Referrals • New health program THREATS • Competition • Decrease patient load • Low patient satisfaction • Increase of charges • Legal threats
  12. 12. TYPES OF ORGANIZATIONS ORIENTED TO ECONOMIC PRODUCTION ORIENTED TO POLITICAL GOALS INTEGRATIVE ORGANIZATION PATTERN MAINTENANCE ORGANIZATION Allocation of power in society Cultural, education & expressionAdjustments of conflicts Production of goods and services
  13. 13. • INITIATING STRUCTURE Job/task-centered leadership Concern for production the degree to which a leader structures the roles of the followers by setting goals, giving directions, setting deadlines and assigning tasks • CONSIDERATE LEADER BEHAVIOR Employee-centered Concern for people the extent to which a leader is friendly, approachable, supportive and shows concern for people/employees LEADERSHIP BEHAVIORS
  14. 14. ADMINISTRATION
  15. 15. MANAGEMENT UTILIZING OR ALLOCATING RESOURCES Manpower Money Material Machine Minute Milieu Methods THROUGH FUNCTIONS Planning Organizing Directing Controlling ACHIEVE GOALS Production of goods and services COMPETENT QUALITY NURSING CARE
  16. 16. NURSING MANAGEMENT• The PROCESS of working through human and physical, technical resource to provide CARE, CURE and COMFORT to patients/clients • A relationship of inputs and outputs in which the workers, physical resource and technology are merged to bring about the ORGANIZATIONAL GOALS for DELIVERY OF QUALITY NURSING CARE • Performing functions of GOVERNANCE and DECISION-MAKING within organizations employing NURSES.
  17. 17. MANAGEMENT PRINCIPLES Management by OBJECTIVE Management by EXCEPTION Management by CONTINGENCY
  18. 18. EXECUTIVE MIDDLE LEVEL FIRST LINE RANK AND FILE/GRASSROOTS CHIEF NURSE Policy Making Strategic PlanningSUPERVISOR Program Implementation Securing influx of patients HEAD NURSE Direct Implementation STAFF NURSES Direct beside care
  19. 19. MANAGERIAL ROLES (Henry Mintzberg) 1. INTERPERSONAL a. FIGURE HEAD b. LEADER c. LIAISON 2. INFORMATIONAL a. MONITOR b. DISSEMINATOR c. SPOKESPERSON 3. DECISIONAL a. ENTREPRENEUR b. DISTURBANCE HANDLER c. RESOURCE ALLOCATOR d. NEGOTIATOR an organized set of behavior that is associated with a particular office or position
  20. 20. PRACTICE TEST 1. CHANGE AGENT 2. SEEKS INFORMATION 3. MAINTAINS NETWORKS OF CONTACTS 4. TRANSMIT INFORMATION EXTERNALLY 5. SYMBOLIC FUNCTION 6. MOTIVATOR
  21. 21. MANAGEMENT KNOWLEDGE, SKILLS, PERFORMANCE
  22. 22. MANAGEMENT KNOWLEDGE Include INFORMATION ABOUT AN INDUSTRY and its Technology Company policies and practices Company goals and plans Personalities of key organization members Important suppliers and costumer
  23. 23. MANAGEMENT SKILLS(Robert Katz) 1. CONCEPTUAL SKILLS  Ability to visualize the organization as a whole, analyze cause and effect of situation 2. TECHNICAL SKILLS  Job specific knowledge to perform a task 3. HUMAN SKILLS  Ability to work well with others
  24. 24. Skill Type Needed by Manager Level Top Managers Middle Managers Line Managers Conceptual Human Technical
  25. 25. EFFECTIVENESS EFFICACYEFFICIENCY PRODUCTIVITY Doing the right thing Doing the things right Making things possible
  26. 26. MAJOR VIEWPOINTS IN DEVELOPMENT OF MODERN MANAGEMENT I. Classical Viewpoint A. Scientific management B. Administrative management C. Bureaucratic Management II. Behavioral Viewpoint A. Early Behaviorists B. Hawthorne studies C. Human Relation Movement III. Quantitative Viewpoint A. Operations research B. Operations management C. Management information science’ IV. Contemporary Viewpoint A. Systems theory B. Contingency theory C. Emerging views
  27. 27. CLASSICAL VIEWPOINT • Emphasis : EFFICIENCY, TASK ORIENTATION, EFFECTIVE OPERATION, HIGH INDIVIDUAL PRODUCTIVITY • Promote managers RIGID YET FAIR CONTROL of employees and employee’s STRICT OBEDIENCE TO THOSE IN AUTHORITY • Overlooks the social needs of workers • MECHANISTIC and PERSONAL
  28. 28. SCIENTIFIC MANAGEMENT Emphasizes the SCIENTIFIC STUDY OF WORK METHODS = IMPROVE WORKER EFFICIENCY Major Contributors: FREDERICK TAYLOR FRANK AND LILIAN GILBRETH HENRY GANTT
  29. 29. FREDERICK W. TAYLOR (1856 - 1915) • FATHER OF SCIENTIFIC MANAGEMENT • Study work scientifically to determine the “ONE BEST WAY” to perform each task
  30. 30. HENRY GANTT (1861 - 1919) • Developed the “GANTT CHART” – graphically illustrates a project from START to FINISH including time intervals for interim steps “Workers should be provided with the means to find their JOB as a source of both INCOME and PLEASURE”
  31. 31. BUREAUCRATIC MANAGEMENT • MAX WEBER – FATHER OF ORGANIZATION THEORY • Organization to OPERATE IN A RATIONAL MANNER • Organizations with HIERARCHICAL STRUCTURE are most effective
  32. 32. ADMINISTRATIVE MANAGEMENT Focused on principle that can be used by managers to COORDINATE THE INTERNAL ACTIVITY OF ORGANIZATION Major Contributors: HENRI FAYOL LUTHER GULLICK LYNDAL URWICK
  33. 33. HENRI FAYOL (1845 - 1925) • “FATHER OF OPERATIONAL MANAGEMENT THEORY” • “FUNCTIONAL APPROACH” to management
  34. 34. FUNCTIONS OF MANAGEMENT PLANNING = EXAMINING FUTURE ORGANIZING = PROVIDING RSOURCES AND BUILDING STRUCTURE to carry out the activities of the organizations DIRECTING = COMMANDING COORDINATING = UNIFYING & HARMONIZING CONTROLLING = VERIFYING that everything occurs in accordance with plans, instructions, established principles and expressed command.
  35. 35. 14PRINCIPLES 1. Division of Work 2.Authority 3.Remuneration 4.Initiative 5.Unity of Command MANAGEMENT
  36. 36. 14PRINCIPLES 6. Subordination of individual interest 7.Unity of Direction 8.Scalar Chain 9.Equity 10.Centralization MANAGEMENT
  37. 37. 14PRINCIPLES 11. Stability of Personnel Tenure 12.Order 13.Discipline 14.Esprit de Corps MANAGEMENT
  38. 38. LUTHER GULLICK & LYNDALL URWICK • Suggested a classification of activities in different function of management POSDCORB 7 ADMINISTRATIVE ACTIVITIES
  39. 39. P O LANNING S D CO R B RGANIZING TAFFING IRECTING MMUNICATING EPORTING UDGETING
  40. 40. BEHAVIORAL VIEWPOINT • A perspective on management that emphasizes the importance of attempting to UNDERSTAND THE VARIOUS FACTORS THAT AFFECT HUMAN BEHAVIOR in organization • Focuses on ORGANIZATIONAL PRODUCTIVITY rather than on individual production MORALE = PRODUCTIVITY
  41. 41. Major Contributors: MARY PARKER FOLLETT ELTON MAYO ABRAHAM MASLOW DOUGLAS MCGREGOR FREDERICK TAYLOR
  42. 42. MARY PARKER FOLLETT (1868-1933) • Management as SOCIAL PROCESS • “POWER WITH” rather than “POWER OVER” • INTEGRATIVE UNITY = OPERATE AS A FUNCTIONAL WHOLE • Managers & workers = PARTNERS
  43. 43. ELTON MAYO/FRITZ ROETHLISBERGER • HAWTHORNE STUDIES • SOCIAL CLIMATE = INFORMAL • Phenomenon based on the concept that human factors like attention, care and recognition and not just physical work environment influence productivity. • HAWTHORNE EFFECT – Tendency for people to perform as expected because of special attention given to them
  44. 44. HUMAN RELATIONS MOVEMENT • Emphasized CONCERN TO WORKERS HUMAN RELATIONS INTEGRATION OF PEOPLE into a work situation in way that MOTIVATES them to WORK PRODUCTIVILY, COOPERATIVELY, with ECONOMIC, PSYCHOLOGICAL AND SOCIAL SATISFACTION. • Focus: WORKERS AS SOCIAL CREATURES • COMMUNCATION and GROUP DYNAMICS
  45. 45. CONTEMPORARY VIEWPOINT SYSTEMS THEORY SITUATIONAL THEORY QUALITY VIEWPOINT THEORY Z
  46. 46. SYSTEMS THEORY • Approach to solving problems within a framework of INPUTS, PROCESS, OUTPUT & FEEDBACK • SYSTEM – a collection of things or beings or people that are inter-related in complex ways and form an identifiable whole; a group of interacting bodies under the influence of related forces • ALL ORGANIZATIONS ARE OPEN SYSTEM THAT INTERACT WITH THEIR ENVIRONMENT
  47. 47. • MAN • MONEY • MACHINE • MOMENT • MATERIALS INPUT • PLANNING • ORGANIZING • DIRECTING • CONTROLLING THROUGHPUT • PRODUCTS • SERVICES OUTPUT ENVIRONMENT FEEDBACK
  48. 48. CONTIGENCY VIEWPOINT • SITUATIONAL APPROACH • means “IT DEPENDS”… appropriate action depends of the particular parameters of the situation • Task of the manager is to identify: – WHICH TECHNIQUE will – in a particular SITUATION – under a particular CIRCUMSTANCES – at a particular TIME, – BEST contribute to the attainment of management goals
  49. 49. QUALITY MANAGEMENT • QUALITY – how well a product or service does what it is supposed to do • TOTAL QUALITY MANAGEMENT – philosophy that emphasizes a commitment to excellence • CONTINUOUS QUALITY MANAGEMENT – Process of CONTINUALLY IMPROVING PRODUCT AND SERVICES QUALITY so as to achieve the HIGH LEVELS OF CUSTOMER SATISFACTION and build stronger customer loyalty.
  50. 50. W. Edward Deming (1900-1993) • “GODFATHER OF THE QUALITY MOVEMENT” • TQM Characteristics: Client focus Total organization involvement Use of quality tools and statistics for measurement Key processes for improvement identified • DEMING believed that poor quality is 85% of management problems and 15% worker problem
  51. 51. WILLIAMS OUCHI • PARTICIPATIVE APPROACH (THEORY Z) • Humanistic nature that focuses on finding better ways to motivate people in order to increase worker satisfaction therefore productivity
  52. 52. 7 “S” BASIC CRITERIA SUPRAORDINATE GOALS: hold organization together STRATEGY: method of doing things STRUCTURE: physical plant and facilities SYSTEM: coherence of all parts for common goal STAFF: concern for the right people SKILLS: developing and training people STYLE: manner of handling people
  53. 53. MOST BASIC AND FUNDAMENTAL ACTIVITY ALL OTHER FUNCTIONS DEPENDS Mental process of DECISION MAKING and FORECASTING CONTINUOUS PROCESS OF ASSESSING
  54. 54. Involves the CHOICE OF GOALS & OBJECTIVES along with: MISSION & VISION PHILOSOPHY STRATEGIES PROGRAMS & PROJECTS PROCEDURES POLICIES RULES STANDARDS necessary for the accomplishment of these objectives.
  55. 55. COMPONENTS OF PLANNING
  56. 56. MISSION/VISION PHILOSOPHY GOALS OBJECTIVES PLANSSINGLE-USE STANDING PROGRAMS PROJECTS POLICIES RULES PROCEDURES Purpose Future role or function Beliefs & values Target or end results Specific General Means Non Recurring Recurring
  57. 57. WHY, HOW and CAN of PLANNING WHAT to do? NURSING ACTIVITIES WHY do it? RATIONALE WHERE to do it? VENUE WHEN to do it? TIME FRAME WHO to do it? PROF or NON-PROF HOW to do it? METHODS, TECHNIQUES HOW MUCH? BUDGETING For WHOM? RECIPIENTS/CLIENTELE CAN? •
  58. 58. REACTIVIST • AFTER A PROBLEM EXISTED • Dissatisfaction with the current situation • RETURNING to previous situation • Done in RESPONSE TO CRISIS • Hasty decisions and mistakes • Problems dealt separately INACTIVIST • CONVENTIONAL PLANNING • STATUS QUO • PREVENTING CHANGE and MAINTAINING CONFORMITY • CHANGE OCCUR SLOWLY PREACTIVIST • UTILIZE TECHNOLOGY to accelerate change • FUTURE ORINTED • Unsatisfied with the past or present • DO NOT VALUE EXPERIENCE PROACTIVIST • INTERACTIVE PLANNING • plan the future rather than to react • DYNAMIC • Key requirement = ADAPTATION • Done in anticipation of changing needs
  59. 59. PRINCIPLES OF PLANNING Based VISION, MISSION, PHILOSOPHY and clearly defined OBJECTIVES Must be PRECISE IN SCOPE, REALISTIC, & TIME BOUND UTILIZES ALL AVAILABLE RESOURCES Pervasive within the ENTIRE ORGANIZATION WELL COMMUNICATED CONTINUOUS FLEXIBILE
  60. 60. PURPOSES OF PLANNING Sets STANDARDS to facilitate effective CONTROL Gives DIRECTION & leads SUCCESS OF GOALS Reduces IMPACT OF CHANGE and COPE WITH CRISIS Reduces WASTE and REDUNDNACY Provides for EFFECTIVE USE OF RESOURCES COST EFFECTIVE Gives MEANING to WORK
  61. 61. TYPES OF PLANNING • ACCORDING TO STRUCTURE OF ORGANIZATION – CENTRALIZED – DECENTRALIZED • ACCORDING TO SCOPE/COVERAGE & LEVEL – STRATEGIC – TACTICAL – OPERATIONAL • ACCORDING STABILITY – MASTER OR STRATEGIC – CONTINGENCY
  62. 62. STRATEGIC TACTICAL OPERATIONAL LONG TERM > 3-5 YEARS INTERMEDIATE MEDIUM RANGE < 5 YEARS SHORT TERM < 1 YEAR TOP MANAGEMENT MIDDLE MANAGEMENT FRONTLINE MANAGEMENT RIGHT THINGS TO DO HOW TO DO RIGHT THINGS DAY-to-DAY activities MASTER DEPARTMENT ROLLING & CONTINUOUS
  63. 63. STANDARDMINIMUM LEVEL OF ACHIEVEMENT ACCEPTABLE TO MEET OBJECTIVES Agreed-on level of performance Characteristics: 1. Predetermined 2. Established by an authority and are accepted by those affected by the standards 3. Used as a measurement tool and therefore must be measurable and achievable
  64. 64. STRUCTURE • Management system used to deliver care SETTING EQUIPMENT POLICIES PHILOSOPHY OBJECTIVES BUILDING FINANCE STAFFING PATTERN PROCESS • Activities nurses perform when giving care STEPS IN THE NURSING PROCESS ACTUAL NURSING PROCEDURE OUTCOME • Designed to measure the results on nursing care RESPONSES CHANGES IN HEALTH STATUS, KNOWLEDGE AND ATTITUDE MODIFICATION OF S/SX SATISFACTION COMPLIANCE TO TX
  65. 65. BUDGETING • FISCAL PLANNING • SYTEMATIC FINANCIAL TRANSLATION OF A PLAN • process of QUANTITATIVE planned original activities • Planning and controlling COST & EXPENSES • COST CONTAINMENT: effective and efficient delivery of services while generating needed revenues for continued organizational productivity
  66. 66. • the QUANTITATIVE STATEMENTS prepared through the budgeting process may include such figures as PROJECTED INCOME, EXPENDITURES and PROFITS • ACCURACY = BETTER USE OF RESOURCES • BEST PREDICTION, A PLAN, NOT A RULE • REQUIRES FLEXIBILITY, ONGOING EVALUATION, REVISION
  67. 67. REVENUE Income EXPENSE Cost PROFIT
  68. 68. TYPES OF BUDGET DIRECT COST: directly related to patient care within a managers unit; (salary, supplies) INDIRECT COST: not explicitly related but is necessary to support care; (electricity and maintenance) FIXED EXPENSES: DON’T VARY in volume; (rent, monthly salary) VARIABLE EXPENSES: increase or decrease depending on the number of patients (cost of supplies, patient meals, laundry of linens) CONTROLLABLE COST: controlled and varied by managers; staffing pattern and mix UNCONTROLLABLE COST: equipment depreciation, supplies, overtime in response in emergency
  69. 69. EXPENSE BUDGET MANPOWER BUDGET OPERATING BUDGET CAPITAL EXPENDITURE BUDGET
  70. 70. BUDGETING METHODS INCREMENTAL BUDGETING FLAT PERCENTAGE INCREASE Simple, quick but generally inefficient (don’t contain cost and no need to prioritize programs and services Multiplying current year expenses by a certain figure (inflation rate or consumer price index) ZERO-BASED BUDGETING Rejustify program, does not assume funding in the past; labor intensive SETTING FUNDING PRIORITIES; DECISION PACKAGES
  71. 71. PARETO PRINCIPLE • Vilfredo Pareto • KEY CONCEPT IN TIME MANAGEMENT 20 % focused efforts results in 80 % outcomes 80 % unfocused efforts results in 20 % outcomes • KEY: focus effort on the activities that will get maximum results
  72. 72. Pareto Diagram • Graphical overview of the process problems, in ranking order of the most frequent, down to the least frequent, in descending order from left to right. • Illustrates the frequency of fault types and prioritizes problem areas (you can decide which fault is the most serious or most frequent offender) • Called the "vital few over the trivial many" rule
  73. 73. TIME MANAGEMENT PRINCIPLES • Based on the principles of: COMMUNICATING PLANNING DELEGATING
  74. 74. TIME WASTERS  External Sources • Interruptions by phone, staff, visitors • Doing work that could be delegated • Doing unnecessary paperwork • Socializing  Internal Sources • Lack of objectives • Failure to establish priorities • Inability to make decisions • Failure to plan and organize work • Inability to delegate • TIME SAVERS • Learning to set priorities • Organizing work • Delegate • Avoiding interruptions • Avoiding wasted motions – learning to be dexterous • Evaluating all paper work, procedures etc and eliminating the unnecessary ones • Avoiding procrastination • Using computer, tape recorder, etc whenever possible • Using the waste basket
  75. 75. ORGANIZING
  76. 76. Involves establishing a FORMAL STRUCTURE that provides the COORDINATION of resources to accomplish objectives, established policies & procedures, and determines position qualification and description. WAY WORK IS ARRANGED & ALLOCATED SYSTEMATIC ARRANGEMENT OF THE ELEMENTS OF MANAGEMENT
  77. 77. COMPONENTS OF ORGANIZING
  78. 78. IMPORTANCE OF ORGANIZING • PROMOTES COLLABORATION & NEGOTIATION among the individual in the group  Improves the effectiveness & efficiency of communication within the organization. • CREATES CLEAR-CUT LINES OF AUTHORITY & RESPONSIBILITY in an organization  Improves the activating & controlling function of the manager.
  79. 79. PRINCIPLES OF ORGANIZING SPAN OF CONTROL CHAIN OF COMMAND UNITY OF COMMAND DELEGATION OF AUTHORITY HOMOGENEITY OF ASSIGNMENT
  80. 80. SPAN OF CONTROL the number of subordinates and different task for which a person in authority is responsible NARROW Span of Control  few people and 1 – 2 task areas BROAD Span of Control  many people and a wide variety of task area Factors to be considered: Level of managerial experience of the manager Skill level of employees Stability of the work unit or department Level of morale among the employees Type of work managed
  81. 81. UNITY OF COMMAND RESPONSIBLE TO ONLY ONE SUPERIOR SCALAR PRINCIPLE HIERARCHY CHAIN OF COMMAND authority and responsibility should flow in clear unbroken lines from the highest executive to the lowest.
  82. 82. • HOMOGENOUS ASSIGNMENT SIMILAR ASSIGNMENT DEPARTMENTALIZATION workers performing similar assignments are grouped together for a common purpose Promotes the specialization of activities, simplifies the administrator’s work, maintain effective control • DECENTRALIZATION PROPER DELEGATION OF AUTHORITY process of conferring specified decision making to the lower levels of organization
  83. 83. ORGANIZATIONAL ORGANIZATIONAL STRUCTURE ORGANIZATIONAL CHART
  84. 84. ORGANIZATIONAL DESIGN a formal, guided process for integrating the people, information, and technology of an organization Refers to the process by which a group is formed, its formal working relationship, its channels of authority, span of control and lines of communication ORGANIZATIONAL STRUCTURE Formal mechanism through which the organization is managed Framework within which people act The basic plan which the manager draws up to help in achieving the objective
  85. 85. INFORMAL STRUCTURE Unplanned and covert Consist of personal and social relationships It is not reflected in the organizational chart FORMAL Planned and made public Describes position, the responsibilities of those occupying the position, and the working relationships Two basic forms: 1. HIERARCHIC OR BUREAUCRATIC MODEL 2. ADAPTIVE OR ORGANIC MODEL
  86. 86. CATEGORY FLATTALL Vertical/Pyramidal Horizontal Number of Levels Span of Control Delegation Authority Control Communication Type Traditional Modern Many Few Narrow Broad Lesser Greater Centralized Decentralized Greater Lesser Complex Decision Making Delay Speed Simplified
  87. 87. ORGNIZATIONAL CHART • A line diagram that depicts the broad outlines of an organization’s structure • Shows how parts of the organization are linked Uses: 1. It outlines administrative control 2. It is used for policy making and planning 3. It is used to evaluate strengths and weaknesses of present structure 4. It shows the relationship with other departments and agencies 5. It is used to orient new personnel to the organization
  88. 88. LILIA DELICANA Chief Nurse VERGIE GUBATANGA Assistant Chief Nurse KRISTEL ORQUILA Nurse Supervisor WILLIAM FRED ITALIA Assistant Nurse Supervisor RANNIE INGADA Medical Ward Head Nurse DG TANINAS Nurse Educator ROSANA BELO Dean Line Authority Command & control Staff Authority Service, advice, support Box Position & placement CARIELLE RIO Surgical Ward Head Nurse Solid or broad Straight line Chain of command Broken line Lines of coordination
  89. 89. Job Analysis • The procedure for determining the duties and skill requirements of a job and the kind of person who should be hired for it 2 Products: JOB DESCRIPTION  A list of a job’s DUTIES, FUNCTIONS & RESPONSIBILTIES (performance description) and reporting relationships & supervisory responsibilities (job relationship) JOB SPECIFICATION  A list of a job’s “HUMAN REQUIREMENTS”, position and qualification (job title)
  90. 90. STAFFING • the process of determining and providing HUMAN RESOURCES to fill the roles designated in the organization through RECRUITMENT: Enlisting personnel for employment SELECTION: Evaluating and choosing from among job candidate INDOCTRINATION: Induction, Orientation and Socialization TRAINING and DEVELOPMENT TRANSFER & SEPARATION of personnel to accomplish the goals of the organization.
  91. 91. STAFFING PATTERN • Involves deciding – WHAT TYPE (MIX) and – HOW MANY (NUMBER) personnel are needed to provide adequate and quality patient or client care (produce desired level of care) – 24 hours a day, 7 days a week and 52 weeks a year (SCHEDULE) and meet the patients demand for care.
  92. 92. STAFF MIX MIX OF PERSONNEL SKILL MIX • Determine the RATIO or mix of nursing personnel (professionals to paraprofessionals) who will provide care.
  93. 93. SCHEDULING • Defined as the time table indicating planned WORK DAYS, DAYS OFF and SHIFTS of nursing personnel Purpose: Appropriate coverage of the job to be done Equitable distribution of workers Provide adequate patient care
  94. 94. ADEQUATE APPLICANT POOL PREEMPLOYMENT SCREENING COMPLETION OF APPLICATION REFERENCE CHECKS, TEST, PE, INTERVIEW EMPLOYER DECISION NOTIFICATION OF APPLICATNTS
  95. 95. • INDUCTION • ORIENTATION: process of familiarizing the new employees & his /her place in the organization • SOCIALIZATION/ENCULTURALIZATION: process by which a person acquires the technical skills of his or her society, knowledge of the kinds of behavior, attitude and values that make CONFORMITY A successful orientation helps speed transition by: building the employees identification with the organization helping the employee become acquainted with fellow personnel providing the employee with important information about the organization
  96. 96. PATIENT CLASSIFICATION SYSTEM WORKLOAD MEASUREMENT TOOL PATIENT ACUITY TOOL a method of grouping patients according to the amount and complexity of there nursing care requirement (articulate nursing workload) that can be clinically observed by the nurse PATIENT ACUITY: measure of nursing workload that is generated for each patient (need or dependency) SICKER ACUITY NURSING CARE
  97. 97. CLASSIFICATION OF PCS (Seago) CRITICAL INDICATOR or CRITERION TYPE  Uses broad indicators such as bathing, diet, grooming, medications and positioning to categorize patient care activities SUMMATIVE TASK TYPE  Requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient.  ASKING THE NURSE for nursing time requirement
  98. 98. FACTORS AFFECTING THE REQUIREMENTS FOR NURSING CARE  ACUITY OF PATIENTS ILLNESS  DEGREE OF DEPENDENCY  COMMUNICABLITY OF THE ILLNESS  REHABILITATION NEEDS, SPECIAL TREATMENTS AND PROCEDURES
  99. 99. PATIENT CLASSIFICATION SYSTEM CATEGORY Category 1: MINIMAL CARE/SELF-CARE Category 2: MODERATE CARE/INTERMEDIATE CARE Category 3: MAXIMUM/TOTAL/COMPLETE Category 4: INTENSIVE/CRITICAL/HIGHLY SPECIALIZED
  100. 100. Category 1: MINIMAL CARE/SELF-CARE – Patient are capable of carrying out all activities of daily CONVALESCING REQUIRES DIAGNOSTIC STUDIES LESS FREQUENT OBSERVATION AND DAILY CARE FOR MINOR CONDITION AWAITING ELECTIVE SURGERY Category 2: MODERATE CARE/INTERMEDIATE CARE – Given to patient who are moderately ill – Require nursing supervision or some assistance, ambulating and caring for their own hygiene
  101. 101. Category 3: MAXIMUM/TOTAL/COMPLETE – Patient need close attention throughout shift – MONITORING; BEDRIDDEN – Patient requires nursing to initiate, supervise, and perform MOST of their activities or who require FREQUENT and COMPLEX medication and treatment Category 4: INTENSIVE/CRITICAL/HIGHLY SPECIALIZED – ACUTELY ILL patients who have high level of NURSE DEPENDENCY, including those requiring INTENSIVE nursing care and are in CONSTANT DANGER OF DEATH
  102. 102. CLIENT CARE DELIVERY SYSTEM MANNER OF ORGANIZING PATIENT CARE ASSIGNMENT SYSTEM FOR STAFFING NURSING CARE MODALITY PATTERNS OF NURSING CARE
  103. 103. Nursing Care Modalities CASE FUNCTIONAL TEAMPRIMARY DISTRICT
  104. 104. CASE METHOD CHARGE NURSE STAFF NURSE PATIENT STAFF NURSE PATIENT  TOTAL PATIENT CARE  ONE- to-ONE  OLDEST METHOD  CONSTANT CARE for a SPECIFIED PERIOD OF TIME  MANY nurses & FEW patients  Common to private duty nurses, ICU, educational purposes
  105. 105. CHARGE NURSE RN MEDICATION NURSE RN ADMISSION NURSE PATIENTS LPN TREATMENT NURSE NURSE ASSISTANT (HYGIENE & BATHING)
  106. 106. FUNCTIONAL NURSING TASK-ORIENTED METHOD  Based on DIVISION OF LABOR  PARTICULAR NURSING FUNCTION  MANY patient, FEW nurse  NO NURSE is responsible for total care of any patient  EFFICIENCY: accomplishment of most work in the shortest amount of time  Disadvantage: FRAGMENTED NURSING CARE
  107. 107. CHARGE NURSE TEAM LEADER RN, LPN, UNA PATIENTS TEAM LEADER RN, LPN, UNA PATIENTS  Goal achievement through GROUP ACTION  DECENTRALIZATION  PATIENT CENTERED CARE  Feature: NURSING CARE CONFERENCE  TL: RN = responsible for coordinating the total care of a block of patients  Size of team: 3-5 nursing staff for 10 - 20 patients in general hospital units  BEST CARE AT LOWEST COST
  108. 108. CHARGE NURSE PATIENT ASSOCIATE NURSE ASSOCIATE NURSE OTHER HEALTH PROVIDER HEAD NURSE PHYSICIAN
  109. 109. PRIMARY NURSING • RELATIONSHIP-BASED NURSING • ASSURES COMPREHENSIVE & CONTINUITY OF DIRECT CARE • PRIMARY NURSE: responsible for the nursing care of patient 24 HOURS a day FROM ADMISSION TO DISCHARGE • Small group: 4-6 PATIENTS • The PN consult HEAD NURSE • Disadvantage: requires the entire staff to be RNs which increases staffing and costs
  110. 110. PRIMARY NURSING A A A C C Accountability Authority Autonomy Comprehensiveness Continuity
  111. 111. DISTRICT NURSING • GEOGRAPHIC ASSIGNMENT OF PATIENT • Modification of TEAM and PRIMARY NURSING • Module: 5 - 6 rooms ( 10 - 20 patients ) side by side along a hall: group of cubicles / room around the nurses station • Each RN, assisted by paraprofessional delivers as much care as possible to a group of patients; RN plans care for all patient in the module
  112. 112. FTE: Full-Time Equivalent The measure of work commitment of a full-time employee 1.0 FTE = 40 hours per week RA 5901 1.0 FTE means a person works  8 hours a day  5 days a week  40 hours per week  for 52 weeks each year  Total = 2,080 hours
  113. 113. NHPPD: Nursing Hours Per Patient Day Standard measure that quantifies the nursing time available to each patient per nursing staff member For example, for a 24 hours period, a unit has 20 patients, with 5 nursing staff available on each shift 5 staff per shift x 3 shifts = 15 total staff 15 staff x 8 hours per shift = 120 nursing hours available for 20 patients 6 hours per patient
  114. 114. NIGHT 18% AM 45% PM 37%
  115. 115. TYPES OF SCHEDULING CENTRALIZED SCHEDULING – Based on the MASTER STAFFING PATTERN that is carried out by 1 person who plans and coordinate the schedule – Made by CHIEF NURSE – Coordination is able to make necessary changes in the rotation in case of illness or emergencies DECENTRALIZED SCHEDULING – Middle and lower level managers have the authority and responsibility to secure adequate personnel for their unit – Done by HEAD NURSE
  116. 116. SELF SCHEDULING PERMANENT SCHEDULING ALTERNATING/ROTATING WORKSHIFT  personnel have alternating work hours among days, evening and nights BLOCK/CYCLICAL SCHEDULING  staffing pattern repeat itself every 4 – 6 weeks VARIABLE SCHEDULING determining the number and mix of staff based on patient needs FLEX TIME
  117. 117. Syndrome of EMOTIONAL EXHAUSTION DEPERSONALIZATION, and REDUCED PERSONAL ACCOMPLISHMENT which happens as a result of the CHRONIC EMOTIONAL STRAIN of working extensively with other human beings, particularly when they are troubled.
  118. 118. • Burn out is related to: Absenteeism Turnover Performance deterioration Decreased productivity JOB DISSATISFACTION • Acknowledge their own feelings and seek assistance accordingly, practice health seeking behavior and find social supports • Supportive workplace can protect against burn out • Most important is SELF CARE • Separate work and personal life
  119. 119. ISSUANCE OF ASSIGNMENT, ORDERS AND INSTRUCTIONS that permit the worker to understand what is expected of him or her, and the GUIDANCE AND OVERSEEING of the worker so that he or she can contribute effectively and efficiently to the attainment of organizational objectives. DOING PHASE OF MANGEMENT ACTIVATING PHASE
  120. 120. COMPONENTS OF DIRECTING
  121. 121. ABILITY TO…. INFLUENCE MOVE PERSUADE
  122. 122. Factors to Consider in the Choice of Leadership Style • MANAGER’S LEADERSHIP STYLE AND EXPECTATIONS – manager’s background, knowledge, values, experiences • FOLLOWER’S CHARACTERISTICS AND EXPECTATIONS – knowledge, competency and level of workers – attitudes and needs of the follower • WORK SITUATION 1. Leader-member relations = how well they get along 2. Task structure/accomplishment = nature of job 3. Position power = extent of power; how legitimate
  123. 123. (Kellerman) • ALIENATED: independent and critical yet passive in their behavior resulting in psychological and emotional distance with their leader • SHEEP: dependent and uncritical; do as they are told by leaders • YES PEOPLE: dependent or uncritical, but very active in their behavior • SURVIVORS: “Better safe than sorry” • EFFECTIVE FOLLOWERS: self leaders, no supervision needed
  124. 124. COMMUNICATION AUTHORITY POWER Exchange of information Right to do or act Ability to do or act LEADERSHIP
  125. 125. Ideation Encoding Transmission Receiving Decoding Response
  126. 126. UPWARD DIAGNOAL DOWNWARD LATERAL Lines of Communication SUPERIORS Motivating SUBORDINATES Directive PEERS, BETWEEN DEPARTMENTS & PERSONNEL Frequently used to coordinate activities OUTWARD PATIENTS FAMILY COMMUNITY
  127. 127. KINDS OF INFLUENCE (Kipnis & Schmidt) ASSERTIVENESS INGRATIATION  Makes another FEEL IMPORTANT ACTING HUMBLY OR FRIENDLY BEFORE MAKING A REQUEST RATIONALITY  Convincing of the MERITS OF A DETAILED PLAN  BLOCKING  Hostile influence, with THREAT of or ACTUAL CUTTING OFF FROM COMMUNICATIONOR INTERACTION
  128. 128. KINDS OF INFLUENCE (Kipnis & Schmidt) COALITION  COLLECTIVE influence, “BACK UP” SANCTION  PUNISHMENT & REWARD on case of cooperation, BEHAVIOR BASED EXCHANGE  OFFERING A FAVOR or PERSONAL SACRIFICE as an incentive for the performance of the request UPWARD APPEAL – Obtaining SUPPORT FROM THE HIGHER UP to push someone into action
  129. 129.  COERCIVE POWER
  130. 130. EXPERT POWER CONNECTION POWER INFORMATION POWER
  131. 131. PRACTICE TEST  Ms. Green, a staff nurse, was well liked by all the staff. They listened and often agreed with her suggestion.  Mr. Orange, the director of a health agency, blocked the promotions if staff exceeded their budget by 2%.  The vice president of nursing has the right to set budget.  The nursing aid intimidated the new nurse manager because she was more familiar with unit procedures.  The head nurse gave the staff nurses choice assignments when their quality assurance ratings improved significantly.  The chief nurse was seen by her colleagues having lunch with the chief of hospital.
  132. 132. • LEADERSHIP STYLES – THE WAY A LEADER GENERALLY BEHAVE TOWARDS HIS FOLLOWERS 1. OPEN SYSTEM – democratic 2. CLOSED SYSTEM – autocratic 3. PERMISSIVE SYSTEM – laissez-faire
  133. 133. AUTOCRATIC DEMOCRATIC LAISSEZ-FAIRE Strong control Less control No control Give orders Offer suggestions Non directive Make decisions Give suggestions Relinquishes decision making to other Leader does planning Participative No plans Directive Participative Passive, uninvolved; inactive; ultraliberal Foster dependency Foster independence Fosters chaos Good quantity and quality of output but little autonomy, creativity and motivation Works when members are knowledgeable, skilful Can work with very mature, autonomous workers
  134. 134. PRACTICE TEST • Strong control • Participative • Passive • Fosters independence • Involves group in decision making • Directive • Close System • No plans • Free rein • Make decisions all • Chaos is likely to develop unless with leader • Ultraliberal • Permissive system • Give orders • Little autonomy & creativity
  135. 135. MANAGERIAL GRID Robert Blake and Jane Mouton • 9 x 9 matrix outlining different management/leadership styles • two key dimensions of managerial behaviors are depicted on grid:  Concern for production (horizontal axis)  Concern for people (vertical axis) • in each dimension the manger’s relative level of concern is rated on a scale of 1 – 9
  136. 136. PRACTICE TEST • “I AM A MIDDLE OF THE ROAD NURSE AND AVOID CONTROVERSY OR TAKING SIDES.” • “THE HOSPITAL PROVIDES ME WITH A JOB WHICH IS ALL I ASK.” • “I CONSULT WITH THE STAFF MEMBERS TO WORK ON MUTUAL GOALS.” • “I AM A STAFF MEMBER’S FRIEND AND WILL DO ANYTHING FOR THEM TO LIKE ME.” • “I EXPECT STAFF MEMBERS TO DO WHAT I THINK THEY OUT TO DO.”
  137. 137. THEORIES OF LEADERSHIP • CHARISMATIC THEORY – Behavioral tendencies and personal characteristics of leaders that create an exceptionally strong relationship between them and their followers • GREAT MAN’s THEPRY – “Leaders are born and not made” • TRAIT THEORY – Effective leadership possess a similar set of traits (relatively stable characteristics, such as abilities, psychological motives or consistent patterns of behaviour)
  138. 138. CORE TRAITS OF LEADER VISION = foreseeing possibilities PASSION = being enthusiastic about the future INTEGRITY = self awareness, trusted CURIOSITY = daring, risk taker FLEXIBILITY INTELLIGENCE Ability SUPPORT others SELF-CONFIDENCE DESIRE to lead
  139. 139. CONTIGENCY THEORY • FRED FIEDLER • Refuted the ideal leadership style theory; identifies three aspects of a situation that structure the leader’s role: – LEADER-MEMBER RELATIONS: involve the amount of confidence and loyalty the followers have in their leader – TASK STRUCTURE: high of it is easy to define and measure a task – POSITION POWER: authority inherent in a position, the power to use rewards and punishment, and the organizations support of one’s decision
  140. 140. PATH-GOAL THEORY • ROBERT J. HOUSE • According to the, leaders can change and adapt their leadership styles CONTIGENT TO THE SUBORDINATE they are leading or the ENVIROMENT in which that subordinates work.
  141. 141. LIFE CYCLE(SITUATIONAL) THEORY • PAUL HERSHEY AND KENNETH BLANCHARD • MOST appropriate leadership styles from the LEVEL OF MATURITY of followers • TASK SITUATION & LEVEL OF GROUP MATURITY • GROUP MATURITY: psychological and job maturity and involves COMMITMENT and COMPETENCE to perform required tasks
  142. 142. SELLING TELLING PARTICIPATING EMPOWERING
  143. 143. RENSIS LIKERT 4 SYSTEMS OF LEADERSHIP AUTHORITATIVE PARTICIPATIVE SYSTEM I EXPLOITIVE AUTHORITATIVE SYSTEM II BENEVOLENT AUTHORITATIVE SYSTEM III CONSULTATIVE DEMOCRATIC SYSTEM IV PARTICIPATIVE DEMOCRATIVE DECISION MAKING: ALL at TOP MOST at TOP Some at LOW Dispersed Group process MOTIVATION Coercion & threat Economic rewards and ego motives + others such as desire for new experiences Economic with GROUP participation COMMUNICATION Downward Most downward; selected Up and down; cautious All directions; open, frank CONTROL ALL at Top Primarily TOP Top but idea solicited Shared
  144. 144. TRANSACTIONAL LEADERSHIP • Leader motivates followers by appealing TO THEIR OWN SELF-INTEREST • Motivate by means of EXCHANGE PROCESS • It is a contract for MUTUAL BENEFIT that has contingent reward • Leader sets goals for employees, focuses on day- day operations and uses management by exception • COMPETITIVE, TASK-FOCUSED
  145. 145. TRANSFORMATIONAL LEADERSHIP • MOST EFFECTIVE and BENEFICIAL, to achieve LONG-TERM SUCCESS and IMPROVE PERFORMANCE • Promotes EMPLOYEE DEVELOPMENT • Inspires her team constantly with A SHARED VISION • Spend a lot of TIME COMMUNICATING • Tend to DELEGATE
  146. 146. TRANSACTIONAL TRANSFORMATIONAL Hierarchy Networking Competitive Cooperative Task focus Process focus Exchange posture Promote employee development Identify needs of follower Attend to needs and motives of followers Exchange for expected performance Influence change in perception Caretaker Role model Set goals for employees Individualized consideration Focus on day-to-day operation Provide sense of direction
  147. 147. EMOTIONAL INTELLIGENCE (EQ) IN NURSING LEADERSHIP • “It requires ability to relate to others if the leader truly wants to achieve desired results” • Emotional Intelligence – defined as a person’s self-awareness, self-confidence, self control, influence and integrity, and a person’s ability to communicate, influence, initiate change and accept change • Leaders who do not develop EQ have difficulty in building good relationships with others
  148. 148. SELF AWARENESS • Self confidence SOCIAL AWARENESS • Empathy SELF MANAGEMENT • Self control RELATIONSHIP MANAGEMENT • Influence SELF SOCIAL RECOGNITIONREGULATION
  149. 149. NEED/CONTENT THEORIES • contend that we behave the way to do because we have internal needs that are attempting to fulfil • Specify what motivates individuals (i.e. the content of needs) – HIERARCHY OF NEEDS THEORY – ERG THEORY – TWO-FACTOR THEORY – ACQUIRED NEEDS THEORY
  150. 150. MASLOW’S HIERARCHY OF NEEDS
  151. 151. TWO FACTOR THEORY (FREDERICK HERZBERG) HYGIENE FACTORS • EXTERNAL • WORK CONTEXT • DISSATISFIERS • Supervision, company policy, working condition, pay, fringe benefits, status, job security, effect on personal life MOTIVATING FACTORS • INTERNAL • JOB CONTENT • MAINTENANCE • Achievement, recognition, work itself, responsibility, advancement, potential for growth
  152. 152. PRACTICE TEST • Happy with being able to help others • Confident of job security • Intellectually stimulated and challenged • Paid adequately • Given opportunity to progress intellectually • Learning new skills • Communicated by the administration • Given the chance to schedule working hours • Qualifying for more responsibility • Working with adequate staffing
  153. 153. COGNITIVE/PROCESS THEORIES • Attempt to isolate the thinking patterns that we use in whether or not to behave in a certain way • Focus the thought processes associated with motivation EXPECTANCY THEORY EQUITY GOAL SETTING THEORY
  154. 154. EXPECTANCY THEORY • VICTOR VROOM • Success of goal- setting in motivating performance depend on establishing goals that have appropriate attributes or characteristics (i.e. specific, measurable, challenging, attainable, relevant to the major work of the organization, time-limited) • We consider three main issues before we expend the effort necessary to perform at given level:
  155. 155. “What is the probability that I can perform at the required level if I try?” “What is the probability that my good performance will lead to desired outcomes?” “What value I place on potential outcomes?”
  156. 156. Reinforcement Theory • Operant conditioning theory or behaviorism • B.F. Skinner • argues that our behavior can be explained by consequences in the environment and therefore, it is not necessary to look for cognitive explanations • relies heavily on the LAWS OF EFFECT • BEHAVIOR MODIFICATION ( the use of techniques associated with reinforcement theory)
  157. 157. • Positive Reinforcement – increasing a desired behavior that involves providing pleasant, rewarding consequences to encourage that behavior • Negative Reinforcement – increasing a desired behavior that involves providing a noxious stimuli so that an individual will engage in the desired behavior in order to stop the noxious stimuli • Extinction – withholding a previously available positive consequences associated with a behavior in order to decrease that behavior • Punishment – providing negative consequences in order to decrease or discourage a behavior
  158. 158. • Responsible, creative, self- possessed, has self- direction and control, enjoys work • Work by opportunities to interact with their superiors than by financial rewards • INDIVIDUAL GOALS • SUPPORTIVE, RELATIONSHIP-ORIENTED • lazy, unmotivated , irresponsible, not too intelligent, dislike work • Will work hard as they must to keep their jobs Manager emphasis: • ORGANIZATIONAL GOALS Management style: • AUTOCRATIC, DIRECTIVE, TASK-ORIENTED Douglas McGregor
  159. 159. JOB REDESIGN TO INCREASE MOTIVATION • JOB ROTATION – periodically moving workers from one specified job to another • JOB ENLARGEMENT – increasing in the number of different tasks that a worker performs within one particular job; JOB SCOPE: increase JOB BREATH; reduce monotony • JOB ENRICHMENT – increasing in he number of tasks in a particular job and giving the workers the authority and control to make meaningful decisions about their work; JOB DEPTH – provide productive climate and high morale
  160. 160. • Sharing of AUTHORITY and RESPONSIBILITY with subordinates and holding them ACCOUNTABLE for their performance
  161. 161. DELEGATION AUTHORITY RESPONSIBILITY ACCOUNTABILTIY Right to do or act Obligation What must be done Liability Answerability Accept consequence of one’s actions
  162. 162. ASSIGMENTS • Describes the DISTRIBUTION OF WORK that each staff member is to accomplish on a given shift or work period. • “WORK PLANS”
  163. 163. 5 Rights of DELEGATION (Hansten, 2004) CIRCUMSTANCES: rules, scope, area of practice, client condition, preferred client results. TASK: should be within the scope of the person’s practice and consistent with the job description PERSON: licensure, certification, job description, demonstrated skill & competence COMMUNICATION, DIRECTION: (A C’s) clear, concise, correct, & complete SUPERVISION: oversee ongoing process and results, reviewing staff performance, updates and “checkpoint” meetings, should ask for input, get person’s recommended solution to problem, and recognize persons effort
  164. 164. • Employee is CAPABLE OF DOING THE JOB. • Delegate BOTH interesting and uninteresting tasks. • Delegate GRADUALLY. • Delegate IN ADVANCE. • CONSULT before delegating. • Avoid gaps and overlaps.
  165. 165. COMMON DELEGATING ERRORS• UNDERDELEGATION: manager’s false assumption of delegation; overburdens the manager • OVERDELEGATION: overburdens the subordinates; because of poor time management, insecurity • IMPROPER DELEGATION: delegating at the wrong time, to the wrong person, for a wrong reason; delegating beyond the capability; delegating without adequate information
  166. 166. AREAS NOT TO BE DELEGATED POWER TO DISCIPLINE and EVALUATE STAFF. MAINTAINING MORALE. OVERALL CONTROL and ARA. Authority to SIGN ONE’S NAME . Jobs that are TOO TECHNICAL
  167. 167. SUPERVISION • SUPERVIDE = OVERSEE or VIEW DIRECTLY • Overseeing the activities of others • It consist of inspecting the work of another, and either correcting or improving the adequacy of performance • It is the active process of directing, guiding and influencing the outcome of a person’s performance of an activity • The provision of GUIDANCE and DIRECTION OVERSIGHT, EVALUATION and FOLLOW UP.
  168. 168. • Process of CONTINUOUSLY REGULATING, MONITORING or EVALUATING organizational activities so that actual performance conforms to expected organizational standards and goals
  169. 169. COMPONENTS OF CONTROLLING
  170. 170. COPING WITH UNCERTAINTY DELETING IRREGULARITIES IDENTIFYING OPPORTUNITIES HANDLING COMPLEX SITUATIONS DECENTRALIZING AUTHORITY
  171. 171. • STRATEGIC CONTROL – monitoring critical environment factors to ensure that strategic plans are implemented as intended, assessing the effects of organizational strategic actions, and adjusting such plans when necessary • TACTICAL CONTROL – assessing the implementation of tactical plans at department levels, monitoring associated periodic results, and taking corrective action as necessary • OPERATIONAL CONTROL – Involves processing the implementation of operating plan, monitoring day-to-day results, and taking corrective action when required
  172. 172. TYPES OF CONTROLS • PRELIMINARY • PRECONTROL • ANTICIPATORY • PREVENTIVE • STEERING • INPUTS FEEDFORWARD • SCREENING • YES-NO CONTROL • PROCESS (ONGOING ACTIVITIES, PRODUCTION, TRANSFORMATION PROCESS) CONCURRENT • POST ACTION • OUTPUT FEEDBACK
  173. 173. QUALITY ASSURANCE  “DOING IT RIGHT”  ASSESS/MEASURE PERFORMANCE  Whether performance meet standard  Improve if not meeting the standard QUALITY IMPROVEMENT  “DOING THE RIGHT THING”  MEET CUSTOMER’S NEEDS  Build /Assess work process  CONTINUOUS or ONGOING improvement performance
  174. 174. • PDCA cycle • FOCUS methodology • Benchmarking • Regulatory requirements • Sentinel Events monitoring • Balanced scorecard concept
  175. 175. PDCA Cycle ?WHAT –trying to accomplish ?HOW – change is an improvement ?WHAT – changes will result in improvement
  176. 176. PLA N DO CHE CK ACT Develop a change, test, activity aimed for improvement Carry change, test out – small scale Study the results. What was learned? What can be predicted? Adopt the change, send through cycle again, under different conditions or abandon the idea
  177. 177. The Methodology for Performance Improvement F ocus on an opportunity for improvement O rganize a team C larify the current process U nderstand the degrees of change needed S elect a solution for improvement
  178. 178. • Tool or process of measuring and seeking out the BEST products, practices, & services against BEST PERFORMING organizations to IMPROVE PERFORMANCE
  179. 179. • Preparing for accreditation survey – used to begin improvement strategies • Adverse SENTINEL EVENT – unexpected occurrence causing death or serious physical or psychological injury • Analysis – provides opportunities for improvement • Linking sentinel event review – identifies strategies for future events • KEY: sharing of information to all
  180. 180. • Progress measurement – balance between: 1. MEDICAL 2. PATIENT SATISFACTION 3. COST OUTCOMES • Change in an area must be evaluated – how it affects balance of another
  181. 181. COST OF CARE PATIENT CLINCAL STATUS PATIENT FUNCTIONAL STATUS PATIENT SATISFACTION
  182. 182. PERFORMANCE APPRAISAL • EVALUATING PERFORMANCE OF EMPLOYEE • Compare an individual’s job performance against standard or objective developed for the individual’s position • May be: 1. FORMAL - regular and methodical 2. INFORMAL - incidental observation &/or recording of work performance
  183. 183. CHARACTERISTICS OF AN EFFECTIVE PERFORMANCE APPRAISAL SYSTEM • ADMINISTERATIVE SUPPORT – Creates the staff time and budget • RELATION TO JOB DESCRIPTION – An employee should be evaluated on the basis of what is expected to accomplish within the organization • CLEAR CRITERIA FOR EVALUATION – The criteria must evolve from the job • IDENTIFIED EVALUATORS – The employees must be evaluated by the immediate supervisor
  184. 184. PERFORMANCE EVALUATION TOOLS • NARRATIVE OR ESSAY TECHNIQUE – Paragraph or more outlining and employee’s strength, weaknesses and potential • RATING SCALES – Consists of a set of behavior to be rated and some type of scale that will indicate the degree to which the person being evaluated demonstrates each behavior • CHECKLIST – Rater indicates by placing a check mark in a column whether the employee demonstrates the behavior
  185. 185. PROBLEMS OF PERFORMANCE APPRAISAL • Time-consuming • A one-way process • Use of inappropriate method • Concentration on faults • Confusion of current performance with promotability
  186. 186. • LOGICAL ERROR – Based on first impression of rater • CENTRAL TENDENCY ERROR – Rates staff as average • LENIENCY ERROR – Propensity to overlook mistakes of workers • HALO-EFFECT – Rate workers same in all performance measures based on their positive characteristics • HORN’S EFFECT – Rating employee very low because of an error committed • HAWTHORNE’S EFFECT
  187. 187. • RATING SCALE – (e.g. QUALPAC- quality of patient care scale) • CHECKLIST – a compilation of all performance expected • PEER REVIEW – evaluation of worker by peers • QUESTIONNAIRE
  188. 188. • Systematic and official examination of a record, process, structure, environment, or account to evaluate performance
  189. 189. • PATIENT CARE AUDIT – patient care is observed and evaluated; (Patient Care Satisfaction Surveys) – CONCURRENT: observed and evaluated through rounds and interview; while patient is receiving service – RETROSPECIVE: questionnaires; review of chart; after receiving care – PROSPECTIVE: attempt to identify how future performance will be affected by current interventions • NURSING CARE AUDIT - examination of documentation of are quality nursing care (review of clinical records of client)
  190. 190. LABOR-MANAGEMENT RELATIONS • LABOR RELATIONS – Relationship between the employees and management • UNION – Workers, who act together, seeks to promote and protect the mutual interest of every member through collective bargaining • COLLECTIVE BARGAINING – Formal negotiation of working conditions • GRIEVANCE PROCESS – Formal expressions of misunderstandings or disputes; contract violations; or inadequate labor agreement
  191. 191. • STRIKE – Concerted work stoppages • LOCK OUT – shutdowns or the suspension or cessation of business operations • WORKPLACE ADVOCACY – Activities undertaken to address problems in their everyday work setting • WHISTLEBLOWING – Act in which an individual discloses information regarding violation of law, rule, regulation, or substantial and specific anger to public health or safety
  192. 192. Means that management uses to bring employees BEHAVIOR UNDER CONTROL.
  193. 193. • PREVENTIVE DISCIPLINE – Encourage to follow standards so that infractions do not occur – Making standards known and understood in advance • CORRECTIVE DISCIPLINE – Follow after infraction of a rule – Disciplinary action • PROGRESSIVE DISCIPLINE – Stronger penalties for repeated offenses – Give opportunity for self correction
  194. 194. • The SELECTION from among ALTERNATIVES of a course of action to attain original goals. • Every action springs from a decision. • Encompasses change, conflict, group dynamic and communication.
  195. 195. 1. Identifying the main problem 2. Generating alternative source and assess all options 3. Weigh all options against set standards or criteria 4. Test possible options 5. Consider consequences of the decision 6. Make final decision 7. Monitor and evaluate
  196. 196. • V.H. VROOM AND P.W. YETTON • Suggests how leaders can determine the appropriate amount of employee participation when making decisions • AUTOCRATIC decisions: leaders make decision by themselves • CONSULTATIVE decisions: leaders share problems with subordinates; still make the decisions • GROUP decisions: leaders share the problem with subordinates and then have the group make the decisions
  197. 197. • HERBERT SIMON • All employees at all levels make decisions as information processor • OPTIMIZING STRATEGY = Economic Man – EXAMINING ALL SOLUTIONS, BEST ALTERNATIVE POSSIBLE with BEST POSSIBLE OUTCOME • SATISFICING STRATEGY = Administrative Man – SOLUTION NOT IDEAL BUT DOES MEET MINIMAL STANDARDS satisfying acceptance; WHAT IS ENOUGH TO WORK OUT • MUDDLING THROUGH STRATEGY – BRINGS RELIEF OF THE IMMEDIATE PRESSURE without attempting to deal with all the issues involved in the problem situation.
  198. 198. DECISION MAKING TOOLS • Decision Grids • Pay-off Tables • Decision Trees • Consequence Table • PERT • Simulations • Models • Brainstorming • Brain writing • Checklist • Step ladder techniques • Nominal technique • Delphi technique
  199. 199. QUANTITATIVE DECISION – MAKING TOOLS/MODELS/AIDS • DECISION GRIDS – Allows one to visually examine the alternatives and compare each against each criteria. – Useful when: • changing the method for managing care on a unit • selecting a candidate to hire from a large interview pool
  200. 200. • PAY-OFF TABLES – The decision aid that fall in this category have a COST- PROFIT-VOLUME RELATIONSHIP and are very helpful when some quantitative information is available. • DECISION TREES – Graphic method that visualizes the alternatives available, outcomes, risks and information needed for a specific problem over a period. – SHOW ALL THE OUTCOMES AND BENEFITS OF A PARTICULAR DECISION
  201. 201. • CONSEQUENCE TABLE – Uses to demonstrate how various alternatives create different consequences. • PERT – Program Evaluation and Review Technique – Tool to determine the timing of decisions – Show amount of time taken and the sequence of events needed to complete the project
  202. 202. • SIMULATIONS – uses models and games to simplify problems by identifying the basic components ad using trial and error to determine a solution. • MODELS – represents most commonly objects, events, processes or systems, developed to describe, explain, predict phenomenon. • BRAINSTORMING – -used to create a free flow of ideas; works best for simple and specific problem. • BRAINWRITING – free association and recording of ideas with verbal interaction.
  203. 203. • STEPLADDER TECHNIQUE – Initially, 2 group members try to solve a problem; then a 3rd member is added, etc. • CHECKLIST – Used to assemble criteria on a checklist, sort it, prioritize it, and eliminate items and add others. • NOMINAL GROUP TECHNIQUE – Members write their ideas down, present their ideas, discuss the ideas, and then vote on the ideas • DELPHI GROUP TECHNIQUE – Allows members who are dispersed over a geographical area to participate in decision making without meeting face to face.
  204. 204. C O N F L I C T
  205. 205. • A situation that exists when there are DIFFERENCES of opinion or opposing views among persons, groups, and organizations • Struggle or strain between 2 OPPOSING FACTORS
  206. 206. • INTRAPERSONAL • INTERPERSONAL  INTRAGROUP – within group  INTERGROUP – between two or more groups • ORGANIZATIONAL – originate in the structure and function of the organization 1. Vertical 2. Horizontal
  207. 207. LATENT PERCEIVE FELT MANIFEST RESOLUTION AFTERMATH Phase of Anticipation Antecedent change Cognitive awareness Intellectualize Affective awareness Internalize Action Taken Overt behavior
  208. 208. AVOIDER Passive Withdrawing, Denying, Suppression Lose-Lose TOUGH BATTLER Aggressive Competing, Forcing, Coercion, Win-Lose FRIENDLY HELPER Non-aggressive Accommodating, Cooperating, Smoothing Lose-Win PROBLEM SOLVER/ DYNAMIC Assertive Confronting, Negotiating Collaborating Win-Win COMPROMISER No clear outcome
  209. 209.  Substituting one thing for another  Process of making something different from what it was  Wholesale change of a system is never good  Implement gradually  Communicate change  Participative
  210. 210. STAGES OF CHANGE: Force Field Analysis (Kurt Lewin) REFREEZING Have internalized new role and adapt to new culture or environment, changes are institutionalized in the corporate culture CHANGE People experiment with new behavior to deal with change, period of confusion and transition, old ways are challenge but no clear picture to the new role UNFREEZING Overcoming “mind set”, replace previous culture with new one, people made aware of problems/performance and need for change
  211. 211. • PERSONAL – Made voluntarily for an individual’s particular reason • PROFESSIONAL – Voluntarily and planned change in job description or obtaining credentials to further individual career goals • ORGANIZATIONAL – Planned change undertaken to improve outcomes, financial standing, or meet other organizational goals
  212. 212. STATEGIES FOR MANAGING CHANGE • EMPIRICAL-RATIONAL – Assume people are willing to adopt change when it’s justified and determine how he can benefit from it • NORMATIVE RE-EDUCATIVE – Assume humans as social animal more easily influenced by others than by facts; focuses on non- cognitive determinants of behaviors • POWER COERCIVE – Involve compliance to the less powerful with the leadership, plans and direction of the more powerful
  213. 213. INNOVATORS People who enjoy the challenge that change brings and often instigate or implement change EARLY ADOPTERS Open to change, will work with change that is brought to them but are not as change- focused as the innovators EARLY MAJORITY People who enjoy the status quo but who will adopt change earlier than average, to avoid being left behind LATER MAJORITY Slower to adopt to change; often expresses reluctance about or skepticism LAGGARDS Last people to adopt to change; maybe suspicious of change, prefer stability and tradition REJECTORS People who openly oppose or reject change
  214. 214. GROUP vs. TEAM Merriam Webster: • GROUP: a number of individuals ASSEMBLED together or having some unifying relationship. • TEAM: a number of persons ASSOCIATED together in work or activity. Collins Dictionary: • GROUP: a number of persons BOUND together by common social standards, interests, etc. • TEAM: a group of people ORGANIZED to work together.
  215. 215. Stages of Group Development
  216. 216. Individual Roles of Group Members 1. Aggressor: expresses disapproval of others’ values or feelings through jokes, verbal attacks, or envy. 2. Blocker: persists in expressing negative points of view and resurrects dead issues. 3. Recognition seeker: works to focus positive attention to himself or herself. 4. Self-confessor: uses the group setting as a forum of personal expression.
  217. 217. Individual Roles of Group Members 5. Playboy: remains uninvolved and demonstrates cynicism, nonchalance, or horseplay 6. Dominator: attempts to control and manipulate the group. 7. Help seeker: Uses expressions of personal insecurity, confusion, or self-deprecation to manipulate sympathy from members. 8. Special interest pleader: cloaks personal prejudices or biases by ostensibly speaking for others.
  218. 218. REFERENCES • Aspires, C. et al. (2005). Leader and management in nursing theories, concepts, principle and practices. • Beltran, E. & Tan, C. (2009). Leadership and management in nursing. • Carroll, P. 2007. Nursing leadership and management a practice guide. • Camano, F. (1998). Introduction to nursing management functions. • Heidenthal, P.K. 2003. Nursing leadership and management. • Marquis, B. & Huston, C. (2006). Leadership roles and management functions in nursing theory and application. • Newstorm, J. (2007). Organizational behavior human behavior at work. • Simms, L. et al. 2005. Professional practice of nursing administration. • Venzon, L & Nagtalon, J. (2006). Nursing management towards quality care.
  219. 219. THANK YOU!!!

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